Personality Disorders and Psychopathy

Personality Disorder (Axis 2)

• Behaviors are similar to Schizophrenia.
• Flat affect, odd thought, or speech patterns.
• Aberrations/disturbances in one’s understanding of reality.
• Differ in their grasp on reality.
• Symptoms do not reach the severity seen in Schizophrenia.

Comprises three disorders:

• Paranoid Personality Disorder
  • Paranoia in one aspect/situation (globally normal behavior).
  • Suspicion of other motives (thinking they are out to get them).
  • Having trust issues.
• Schizotypal personality disorder (cognitive & behavior).
  • Symptoms of Schizophrenia that are not severe enough to warrant a diagnosis of Schizophrenia.
    • Mild perceptual and cognitive distortions:
      • Odd beliefs.
      • Unusual perceptual experiences.
    • Odd/Eccentric behaviors:
      • Odd speech pattern.
      • No operational definition of odd.
• Schizoid personality disorder (emotional)
  • Flat affect- not responding in an appropriate way to what one is experiencing.
    • Affective system not functioning properly
  • Interacting with the world based on the way the body feels (anxious, calm, etc).
  • These individuals can’t always live independently.

General personality disorder:

• Criterion A: (diagnosis)
  • An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:
    • Cognition (i.e, ways of perceiving and interpreting self, other people, and events).
    • Affectivity (i.e, the range, intensity, lability, and appropriateness of emotional response).
    • Interpersonal function.
    • Impulse control.
• Criterion B
  • The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
  • Doesn’t just show up in one area but multiple.
  • Your behavior is not being explained by your situation- it is something interpersonal.
  • Behavior not flexible enough to behave appropriately in situations (wedding vs. a funeral).
• Criterion C:
  • The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important area of functioning (it’s only a problem if it’s a problems).
  • Interferes with functioning.
• Criterion D:
  • The pattern is stable and of long duration and its onset can be traced back at least to adolescents or early childhood.
  • Your personality is not fully yet developed.
  • Cannot be diagnosed with a personality disorder as a child.
• The 3 clusters of Personality disorder: (characteristic)
  • Cluster A: odd-eccentric

Cluster A: schizotypal personality disorder

• Jim very odd beliefs that believed in fairies and that you can feel their presence.
• As well as thunderstorms might be interpreted by a message not to shower one day.
• Odd feature of jim behavior breaks out into a silly grin and laughs for no apparent reason.

Cluster B: Dramatic-emotional (characteristic)

• Histrionic personality disorder:
  • Manipulative and potentially uncaring behaviors.
  • Show little regard for others and potentially their own safety.
  • low on the spectrum of empathy.
  • Emotional Dysregulation.
  • Can demonstrate highly erratic emotional responses.
  • Inappropriately sexual and seductive behavior.
  • Extreme focus on appearance.
  • These disorders are similar in these symptoms but they are functionally different.
  • Exaggerated emotionality that lacks depth.
  • Emotions are shallow and shift rapidly.
  • Discomfort when not center of attention.
  • Constantly seeks reassurance, approval, and praise.
  • Inappropriately sexual and seductive behavior.
  • Extreme focus on appearance.
  • Cognitive-Behavioral Models (sense of self).
  • Discomfort with and deficit in interpersonal relations.
  • Want close relationships but often avoid them.

Core Beliefs:

• Self:
  • If I can’t entertain people they will abandon me.
• Other:
  • If other people don’t respond to me they are rotten.
• Learning History:
  • Selective interpersonal reinforcement by family and peer relationships leads to excessive attention-seeking behaviors.
• Histrionic personality disorder
  • Key thing to remember is that there is a difference between topography (what the behavior look like) and underlying functions.
  • The thing that differentiates disorders among this cluster, or any cluster, is the underlying functions= why the person is doing it what the behavior is trying to achieve.
  • Histrionic shifts in emotion are not comparable to those shifts in Bipolar disorder.
  • In BD, mood changes are due to brain chemistry, In HPD, the emotion shifts might last longer and are usually aimed at getting attention or connection from others.
  • However, these shifts tend to be for longer durations.
  • What these individuals display to people (topography) is different than what is going on internally (underlying function).
  • “Attention seeking disorder”.
  • They will seek any attention, good or bad.
    • Differs from narcissism which seeks attention primarily for ego boosts and they are more selective in what they want.
    • Ex. kids may act out as a way to receive attention, and the attention is reinforcing, this is similar to how histrionic may act.
  • They tend to have low insight.
    • She starts to suspect he’s having an affair – it couldn’t possibly be her fault –low insight.
    • She doesn’t believe what she’s doing is bad.
  • In the past, her charm and appearance did all the work for her, but now something has changed.
  • sensation-seeking
    • Hilde
    • She expresses a senses of superficiality in both her outward and inward expression.
      • “She’s larger than life”.
      • “At first they may draw people in but as relationship progress those involved start to realize there is not much below the surface.
    • Her husband struggles to feel seen and heard in their relationship because it's all about Hilde.
    • Hilde’s upbringing
      • She was praised her her appearance, not her intellect.
      • What is reinforced or punished by others in our environment calibrates our sense of self worth.
      • Hilde’s personality trait that could have blossomed remain dormant bc they were not reinforced, rather they were punished.
      • Had a history of reinforcement during a critical period of her development for certain behaviors that are now maintained in her adult life.
      • Those old behaviors that were once adaptive in another environment don’t make sense.
• Cluster B: Dramatic- emotional
  • Antisocial personality disorder:
    • Psychopathy/sociopath is not the same thing as.
      • ASPD- is a DSM diagnosis that tries to capture psychopathy but only capture some features.
    • Characterized by a disregard for and violation of the rights of other (core of this definition).
    • Even though people recognized psychopathic traits for a while, it came out fist in the DSM-II.
    • ASPD is overly focused on criminality, and the idea of defining psychopathy on the grounds of criminality is misguided.
    • Failure to conform to social norms with respect to lawful behavior.
    • Deceitfulness.
    • Impulsivity or failure to plan ahead.
    • Irritability and aggressiveness.
    • Reckless disregard for safety of others.
    • Consistent irreparability.
    • Lack of remorse for behaviors.
      • This feature that really gets a psychopath.
    • Early history: how this disorder was understood in the past
      • Moral insanity: (early term ASPD)
        • Not psychotically deranged (they don't hear voices or lose touch with reality).
        • Not deficit in reasoning abilities (they can think and reason normally).
        • “Constitutionally deficient in moral faculties” (seemed like they were born without a moral compass- they just don’t care about right or wrong, and they don’t feel guilt for hurting others).
    • Antisocial personality disorder DSM 3:
      • Diagnosis focused on antisocial behaviors and social deviance → problematic b/c there are lots of things that influence criminality, so you tend to view criminal behavior as an individual responsibility.
      • Just because you engage in criminal behavior doesn’t mean you’re a psychopath.
        • Eg: acts of aggression.
      • Critiqued for de-emphasis on trait and personality characteristics (and instead focuses most on behavior, which can be socially determined).
      • A lot of psychopaths may not break the law or get caught, so it is important to focus on traits like high impulsivity (these individuals more likely to get caught), high constraint (limit).
• Psychopath:
  • Term similar to ASPD, but includes:
    • Grandiosity, arrogance, superficiality.
    • An inability to form emotional bonds.
      • Includes a lack of understanding of how social relationships and interpersonal closeness works.
    • A lack of anxiety.
      • Low level of baseline arousal, even in the face of risk in order to “feel something,” → the experience must be high in intensity.
    • Some personality traits on their own can be useful or healthy but when combined together it can be problematic.
  • Prevalence: overrepresented in criminal and substance abuse settings:
    • 76% of prisoners diagnosed with ASPD.
      • Most of them were not psychopathic (demonstrating the problem with ASPD def since it was was categorized as criminal behavior).
    • Community samples:
      • 8% of men.
      • 3% of women.
  • Genetic contribution:
    • The environmental factors don’t seem to have a strong as an influence as the genetic factors (psychopathic traits an amenable to environmental influence, but have a strong genetic basis).
  • Early learning environment (1)
    • Characterized by either:
      • Passive or neglectful parenting attitudes (don’t really pay attention to the child).
      • Overly harsh parenting styles (strict, punishing, abusive).

Early learning environment (2)

• Passive or neglectful parenting attitudes:
  • No demands for responsible and non-aggressive behaviors.
    • When parents don’t teach or expect responsible, kind, or respectful behavior, the child never learns how to act properly.
  • Children who receives little response- contingent attention for (+) behaviors might engage in (-) behaviors for attention.
    • If a child only gets attention when they do something bad (and get ignored when they behave well), they might keep doing bad things just to get noticed.Early learning environment (2)
• Harsh parenting styles:
  • Use of aggression for discipline.
    • Modeling conflict and problem-solving (the child learns from watching their parents).
    • Develop hostile information processing style in social interaction (the child believe someone is out to get them as a result they often react with anger and aggression in social situations).
  • Learning and performance deficits
    • Deficits in acquiring learning responses:
      • Incapable of profiting from reward/punishment:
        • Psychopaths performed as well as controls when incorrect responses resulted in loss of cigarettes or money.
        • Not responsive to shock or positive or negative social comments.
        • Psychopaths don’t learn from rewards or punishments like most people do. They don’t care much about losing something or being praised, so it’s hard to teach them to change their behavior using normal methods.
    • Learning and performance deficits (2)
      • Deficits in acquiring fear responses:
        • Psychopaths slow to develop conditioned response to fear.
        • Inclined to ignored painful shocks that control learned to avoid.
        • Less influences by fear reaction.
        • Behaviors unfettered by psychological deterrents such as anxiety and fears of consequences.
        • Psychopaths have trouble learning fear. Most people learn to be afraid of something if it’s paired with pain or punishment.

Understanding Arousal in ASPD Individuals

• Psychopaths don't learn this fear reaction as easily. They don’t make the connection between the warning sign and the pain.
• Psychopath don't ignore things other would avoid, even when they get painful shocks, they don’t try as hard to avoid them like other do.
• Psychopaths are not guided by fear or anxiety, they don’t seem to feel much fear, guilt, or worry (so they don't feel anxious about getting in trouble).
• Chronic low levels of arousal:
  • Aversive physiological state resulting from a lack of novel/rewarding stimuli.
    • Lower baseline levels of arousal and rapid adaptation to novel stimuli.
    • ASDP individuals spend less time attending to boring material.
    • Higher initial attention to novel stimuli, rapid habituation.
  • Need to increase arousal levels, ASPD individuals will engage in higher-risk sensation-seeking.

Cluster C: Anxious-fearful

• Extreme concern of criticism and abandonment that leads to impaired relationships.
• Cluster C disorders:
  • Avoidant personality disorder:
    • Feelings of extreme social inhibition, inadequacy, and sensitivity to negative criticism and rejection.
    • Avoidance of activities of daily living (e.g. work) involving people for fear of criticism or rejection.
  • Dependent personality disorder:
    • Feelings of helplessness, submissiveness, dependence, reassurance seeking.
    • Difficulty making independent decisions.
    • Avoidance of adult activities and tolerance of abuse and maltreatment
  • Narcissistic personality disorder:
    • Background:What is a Narcissistic personality?
      • Narcissistic personality disorder became official in DSM 3 from the Greek mythology Narcissus.
      • Experts from different field describe narcissism differently.
        • Because of that they way it’s diagnosed can vary.
        • Some studies say no one has it, while other say up to 5.7% of people might.
        • It been compared to “Tower of Babel” meaning everyone is speaking different languages when it comes to defining narcissism

Conceptions and Measurements of Narcissism

• Clinical and social/personality psychologists differ in how they conceptualize and measure narcissism.
• Ultimately, there is not one gold standard definition or theatrical model of narcissism.
• Healthy Narcissism
  • Consensus that there exist both healthy expressions and maladaptive form of narcissism:
    • Psychologists agree that narcissism isn’t always bad. There are healthy and unhealthy (maladaptive form).
    • Healthy narcissism means:
      • You can keep a positive view of yourself in a balance way.
      • You want to feel good about who you are- and that’s normal.
      • You look for validation or encouragement from other sometimes (like praise or support), but not in extreme was.
      • You’re motivated to grow, succeed, or to be recognized, but you don’t harm other or ignore their need to do it.
    • On the other hand, Narcissism contribute to well-being by increasing an individual’s sense of personal agency (Oldham & Morris 1995):
      • Asserting interpersonal dominance (Brown & Zeigler hill).
      • Fueling approach and achievement motives (e.g. competition,, mastery, lowering avoidance; Foster & Trimm).
        • You won’t compete/be driven towards mastery if you’re not feeling confident in yourself.
    • High scores on the narcissistic personality inventory (NPI):
      • Negative associations with traits neuroticism and depression.
      • Positive association with achievement motivation and self-esteem.
    • Analyzing measure of narcissistic emption, attitudes, and behaviors consistently highlights an adaptive subtype of narcissistic personality:
      • Autonomy subtype (Wink et al. 2005)
        • Correlated with self-ratings and partner-ratings of creativity, empathy, achievement orientation and individualism
      • High-funtioning/exhibitionstic
        • Exaggerated sense of self-importance
        • Outgoing, articulate, and energetic
        • Show “good adaptive functioning and use their narcissism as motivation to succeed”.

Pathological narcissism

• There two main dimensions of pathological narcissism:
  • Grandiose narcissism
  • Vulnerable narcissism
• Grandiose narcissism- The broad construct of narcissism is most often associated with, conceited, and domineering attitudes and behaviors (Buss & Chiodo)
  • Also internal manifestations:

Grandiose Narcissism

• When bad things happen, these individuals don’t recognize it as a reflection on them.
• Individuals can’t profit from mistakes
• With narcissists they can’t recognize they failed, so how will they learn from their mistakes?
• If you’re unable to recognize failure or mistakes you’re doomed to make errors again, so you have individuals with inflated sense of self without accomplishment of skill
• There’s a high degree of correlation between grandiose narcissism and psychopathy
• Repressing negative aspects of self
• Distorting disconfirming external information
  • Can lead to entitled attitudes and an inflated self-image without requisite accomplishments and skills
• Engaging in regulatory fantastic of unlimited power, superiority, perfection, and adulation.

Grandiose narcissism/malignant subtypes:

• Seething anger
• Manipulativeness
• Pursuit of interpersonal power and control
• Lack of remorse
• Exaggerated self-importance
• Feeling of privilege
• Externalize negative life events
• Having little insight into their behavior

Vulnerable narcissism (more insecure type)

• DSM-V criteria for NPD is most closely aligned with grandiose narcissism
• Fragile/hypersentive subtype is characterized by:
  • An inability to consistently maintain a grandiose sense of self
  • Prone to narcissistic injury
  • Emotional states characterized by shame, anxiety, depression, and feelings of inadequacy
• For grandiose narcissist it takes them a strong salient event or push them into vulnerability
• For vulnerable narcissist they want to fall into the grandiose subtype, but there’s too many things holding them back

Grandiose vs. Vulnerable

• Grandiosity is harder to maintain (can’t be maintained)
• When a grandiose narcissist is young they can maintain a positive self image/ in a protective bubble

Etiological Factors

• Studies show Heterogeneity that ranges widely
• When we’re talking about etiology it’s confusing because there’s so much heterogeneity in defining narcissism. We can’t get a good read on that and we don’t know if its narcissism proper or if there are other things being inherited that lead people to be narcissist as a result
• You need some degree of inoculation in life, but narcissists are just lacking that
• You need to develop sense of self that has value
• People like Brain (case study from class) are gonna be so invested in maintaining a positive view of themselves Borderline personality disorder:
  • It’s another thing as you age as grandiosity isn’t realizes (e.g. you think you should be the CEO of microsoft)
  • It hard to go on a day to day basis being a grandiose narcissistic
  • Things that might seem minor to toher may seem a lot for narcissistic
  • People in grandiose state aren’t looking for treatment versus a vulnerable state
  • Vulnerable state where they’re more inclined to listen to someone else

Pathological narcissism: Brain #1

• Brain would stab in the back to get what he wants, his demeanor was usually cocky, yet he has self esteem and depression as well as self hate
• He believed rules and law did not apply to him he believed he “underserved” a ticket when he got pulled over by the police
• Need to be admired by others when he got to know people he would often get tired leading to think he was superior to them. Often felt envy and competition
• He was extremely sensitive to criticism so oftenly became enraged but he would also think a lot about it and became devastated or humiliated
• Broke up with multiple girlfriends bec they thought he was self absorbed so he would use his male superior to mock them but also deeply thought if he would ever be in an ongoing commitment

Borderline personality disorder:

• Characterized by: Instability in emotion, cognition, behavior, sense of self and interpersonal relationships
• Efforts to change the name to “unstable personality disorder” and described as “emotionally unstable disorder” in the ICD-10
• Profound fears of abandonment (real or imagined) and desperate bids to avoid abandonment
• Amanda #1
  • Amanada would cut herself and exaggerate the severity of her problems to avoid discharge from the hospital
  • Amanda's mother and father got divorced leading to her father leaving the family and she had all the responsibility to take care of her sibling bc her mother was often working and she often would think how her life would've been of her father was with her
  • Her stepfather would began sexual abusing her and she felt unable to tell anyone
• Early learning factors:
  • Early lives involve significantly more maternal and paternal absences, more discord between parts, more experiences of being raised by other relatives or in foster homes, and more physical violence in the family
  • BPD patients are at a higher likelihood of having experienced early trauama in the form of physical abuse, sexual abuse, or neglect (e.g. Zanarini)
• A common theme across theoretical model of borderline personality disorder is an invalidating early attachment environment
  • “Good enough mothering” (Winnicott, 1953)
  • Linehan (1993)
    • Parental response to the child’s inner experiences are met with inappropriate or erratic responses from parents and caregivers
• Instability in self-concept
  • Good and bad object relations
  • Positive vs negative attachment experiences/memories
• Biological factor:
  • In a twin sample, Torgersen et al. (2000) found a concordance rate of 70% in monozygotic (MZ) twins compared with a concordance rate of 35% for dizygotic (DZ) twins
    • Note: to date: no adoption studies have been conducted
• What is inherited:
  • Much like other personality disorder, it is more likely that certain predisposing traits are inherited as opposed to symptoms of the disorder
    • E.g. rates of anxiety and mood disorder, impulse control problem, ASPD, affective instability, and cognitive dysregulation found in relative of those with BPD
  • Identical twins (MZ), who share 100% of their genes, were 70% likely to both have BPD if one twin had it
  • Fraternal twins (DZ), who shares 50% of their genes, were only 35% likely to both have it
    • This suggests that genes play a role but not entirely
• What is inherited?
  • They inherit trait that increase the risk of:
    • High anxiety
    • Mood problem
    • Poor impulse control
    • Traits linked to antisocial behavior
    • Emotional instability
    • Thinking difficulties

Textbook: Chapter 14 Borderline disorder

What does it mean that BPD has been referred to as a disorder of “stable instability”? In what ways are individuals with BPD “unstable”?

• BPD “stable instability”: instability in mood such as intense anger or in periods of rapidly changing negative emotion often in response to interpersonal stress. As well as instability of self image in who they are/or what they want
  • E.g. emotions, self image, relationships, behavior, self harm

What are the clinical features of BPD as per Table 14.1?

• Five or more of the following systems are required for the diagnosis of BPD:
  • 1. Profound fears of abandonment (real or imagined) the person make frantic and sometimes efforts to avoid abandonment by others
  • 2. Interpersonal relationships that are both intense and unstable and that alternate between feelings of idealization and devaluation of the other person
  • 3. Identity disturbance characterized by a highly unstable of self or markedly disturbed self-image
  • 4. Impulsive behavior in at least two areas that have the potential to be self-damaging or to have harmful consequences (such as substances abuse, reckless driving, binge eating, unsafe sexual behavior, excessive spending)
  • 5. Recurrent self-mutilating behavior or suicide threats, gesture, or suicidal behaviors
  • 6. Highly reactive mood, leasing to affective instability (e.g intense negative affect such as depression, irritability, or anxiety that lasts a few hours or rarely a few days
  • 7. Persistent feeling of emptiness
  • 8. Intense or inappropriate anger that is difficult to control (e.g. constant feeling of anger)
  • 9. Brief periods of paranoid ideation or dissociative symptoms when under stress

From where does the term borderline come? Be familiar with the types of patients that Stern (1938) and Knight (1953) were working with and how this informed their choice of the term.

• Borderline patient was first described by the psychoanalysis Aldolf Stern
• Stern's use of the term borderline was meant to reflect his view that the disorder does not fit well within the existing classification system, which was principally oriented around differentiating between neurosis and psychosis.
  • Type of patients he described including hypersensitivity, difficulties in reality testing, and negative reaction in therapy are recognizable to those familiar disorder
• Knight on the other hand described a group of patients with severely impaired ego functions and primary process thinking, which is a type of thinking that reflects unconscious wishes and urges. Knight considered the disorder to be on the border not just of neurosis but both neurosis and psychosis
• The term borderline became used to describe atypical (unusual) parents who were neither neurotic nor psychotic but were problematic to deal when when they were in the hospital

According to APA, approximately what percentage of patient with BPD are women? What are some theories about why this might be (other than that a genuine difference exists across gender)? What did Torgersen et al. (2001) and Lenzenweger et al. (2007) find? What do the authors of the chapter ultimately conclude with respect to gender differences in BPD?

• Women accounting for 75% with BPD
• Few theories for this is:
  • 1. Women may be more likely to seek treatment, so more women are diagnosed making it look like more women have BPD
  • 2. Clinical samples (people in therapy or hospital) are not the same as the general population, so the data may be skewed
  • 3. Some have wondered if the diagnostic criteria are biased toward female traits but research has little support for this
• Torgensen and Lenzenweger et al. both report no gender differences in the prevalence of BPD
• Therefore, there is a little evidence that BPD may not be actually be more common in women

What to Linehan (1993) and Gunderson (1996) consider to be the core features of BPD?

• Linhean considered “affective instability” or bw the core of BPD
  • Rapid mood changes, extreme reactivity to the environment, and dysthymic baseline mood that characterizes the disorder
• Gunderson takes a more interpersonal perspective and highlight “fear and intolerance” of aloneness as central to the disorder
  • Extreme fear of abandonment and the accompanying “frantic” effort to avoid it are at the core of BPD

What are the main components of Linehan’s (1993) biosocial theory? What does she consider as the key environmental factor in the development of the disorder?

• Biosocial theory of BPD:
  • Biological vulnerabilities: Linehan suggests that biological or temperamental factors contribute to BPD. People with BPD often have:
    • High emotional sensitivity (easily triggered)
    • Intense emotional reactions
    • Slowly recovery from emotional arousal (difficulty calming down after being upset)
  • Environmental factors: an invalidating family environment
    • Invalidation happens when a child’s emotional experiences or expression are dismissed, ignored, or responded to inappropriately
    • Impact of invalidation:
      • Heightened emotional arousal: invalidating increase emotional reactivity
      • Failure to label emotions
      • Self invalidation

What types of negative life events characterize the youth of those later diagnosed with BPD? What is the main problem with almost of the studies that examine the early life experiences of BPD patients and why is this a problem?

• Type of negative life events of those later diagnosed with BPD:
  • Childhood trauma
  • Parent neglect
  • Early family dysfunction
  • Loss or separation from primary caregivers
• Main problems with most studies:
  • Reliance on retrospective reports: most studies rely on patients with BPD recalling their early life experiences, which can lead to biased or distorted recollections. E.g they may exaggerate or misremember the trauma they experienced
  • The problems with retrospective data: because patients are often asked to look back on their lives and report their experiences, these accounts might not be fully accurate or might be influenced by the siroder itself

What is attachment theory and how has it been used to understand BPD? What specific styles of insecure attachment appear linked to BPD in empirical studies? Be familiar with Bateman and Fonagay’s notions of what links attachment style and BPD?

• Attachment theory developed by John Bowlby proposed that infants develop an internal working model of themselves and others based on their early attachment experiences. These models influence how they perceive an engage relationship through their lives
  • Secure attachment- occurs when caregivers are consistently responsive and nurturing, fostering a sense of safety and security
  • Insecure attachment- arises when caregivers are neglectful or abusive leading to relationship being unreliable
• Link between attachment and BPD:
  • People with BPD tend to have poor relationships with stability and extreme emotional reactions to perceived rejection, often triggering self- destructive behaviors or emotional outbursts
• Insecure attachment linked to BPD:
  • 1. Disorganized attachment
    • Most frequently associated with BPD, often experienced chaotic or frightening caregiving, such as neglect or abuse, leading them to feel both drawn to and terrified of their caregiver.
      • Leads to confusion and difficulty forming relationships in adulthood
  • 2. Preoccupied with anxious attachment
    • Excessive preoccupation with attachment figure and a fear of abandonment
  • 3. Avoidant attachment
    • Less common in BPD but show feature of avoidant attachment
    • Struggle with emotional regulation and expressing their need within relationships
• Bateman and Fonagay’s notions: refers to the term of mentalization
  • Failure in mentalization can result from early attachment disruptions
    • When caregivers are neglectful, abusive, or emotionally unavailable, children fail to develop a secure internal working model
    • This can lead to poor emotional regulation, identity confusion, and difficult interpreting social cues

Know the different forms of executive neurocognition and know the associated findings that link deficits in these area to BPD.

• Executive neurocognition- refers to a set of high-level cognitive processes that allow individual to control and regulate their thought, behaviors, and emotions in the survive of goals especially when faced with conflict
  • 1. Interference control: the ability to suppress dominant, automatic, or irrelevant responses in order to focus on goal relevant stimuli
  • 2. Cognitive inhibition: the ability to suppress irrelevant or unwanted thoughts from working memory
  • 3. Behavioral inhibition: the ability to inhibit motor responses or switch from one behavioral set to another
  • 4. Motivational or affective inhibition: the ability to regulate behavior in the presence of emotional or motivally relevant stimuli
    Obsessive compulsive personality disorder
  • A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four or more of the following:
    • Is preoccupied with details, rules, lists, order, organization, or schedules to the context that the major point of the activity is lost
    • Show perfectionism that interferes with task completion (e.g. is unable to complete a project because his or her own standards are not met)
    • Is excessively devoted to work and productivity to the exclusion of leisure activities and friendship (not accounted for by obvious economic necessity)
      • They care so much about being perfect and in control that it actually get in the way of living life
    • Indicated by four or more of the following:
      • Is over-conscientious, scrupulous, and inflexible about matters of mortality, ethics, or values (not accounted for by cultural or religious identification)
        • The person is overly strict and rigid about what right or wrong- they stick to their own moral or ethical rules, even when it doesn’t really make sense or isn’t based on religion or culture
      • Is unable to discard worn-out clothes or worthless object even when they have no sentimental value
      • Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
      • Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
      • Shows rigidity and stubbornness
        • The person is very stingy with money, they don’t like spending it on themselves or others because they’re always worried about worst-case scenarios in the future
        • They are rigid and stubborn, meaning they refuse to change their mind
    • Prevalence:
      • Most common personality disorder (deReus and Emmelkamp), with some evidence of high prevalence in men
    • Diagnostic issues:
      • Critiqued for lacking a hallmark diagnostic feature

Heterogeneity in OCPD and Empirical Findings

• DSM-V recommends perfectionism as the primary feature
• Heterogenous diagnostic category (meaning people with OCPD can look very different on which symptoms they have)
• Heterogeneity is a diagnostic entity has severely impaired empirical finding on etiology and course:
  • Different studies suggest it is stable over time whereas others do not, owing to the specific symptoms in play (problems delegating versus miserly behaviors)
  • Some studies suggest major overlap with OCD whereas other show them as distinct
  • Inconsistent findings with respect to etiological factors (e.g. heritability)
• In short: OCPD is common but hard ot define clearly, which makes it difficult to study and understand fully

Sexual Paraphilias

• Types of sexual disorder
  • Sexual dysfunction:
    • Problem in the psychophysical characteristics of the sexual response cycle
      • Represent quantitative problem with the strength/intensity of sexual response